BMJ Open (Dec 2013)
Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide
- ,
- J Lennert Veerman,
- Sarah Lewis,
- John Britton,
- Bruce Neal,
- Kathryn G Andrews,
- Goodarz Danaei,
- Majid Ezzati,
- Yanping Li,
- Yu Chen,
- Farshad Farzadfar,
- Jean-Michel Gaspoz,
- Idris Guessous,
- Lital Keinan-Boker,
- Paul Elliott,
- Carukshi Arambepola,
- Antonia Trichopoulou,
- Philippos Orfanos,
- Martin C Gulliford,
- Renata Micha,
- Dariush Mozaffarian,
- Wen-Harn Pan,
- Shoichiro Tsugane,
- Habibul Ahsan,
- Manami Inoue,
- Luz Maria Sanchez-Romero,
- Andrew Fogarty,
- Christos Pitsavos,
- Edward Giovannucci,
- Stefaan De Henauw,
- Stephen S Lim,
- Cho-il Kim,
- Inge Huybrechts,
- Didier Garriguet,
- Simón Barquera,
- Katia Castetbon,
- Neville Calleja,
- Peilin Shi,
- Hsing-Yi Chang,
- Yasuhiro Matsumura,
- Hubert Barennes,
- Guansheng Ma,
- Shahab Khatibzadeh,
- Saman Fahimi,
- John Powles,
- Morteza Abdollahi,
- Anahita Houshiar-rad,
- Eda Koksal,
- Sahar Zaghloul,
- Sirje Vaask,
- Ana Baylin,
- Simon Forsyth,
- Rosely Sichieri,
- Christian Haerpfer,
- Ian Brown,
- Demosthenes B Panagiotakos,
- Jacqui Webster,
- Androniki Naska,
- Dorothy Gauci,
- Rebecca E Engell,
- Tim E Byers,
- Stephanie Smith-Warner,
- Ibrahim Elmadfa,
- Mayuree Rao,
- Pamela A Abbott,
- Enrique O Abeyá Gilardon,
- Suad N Al-Hooti,
- Wulf Becker,
- Peter Bjerregaard,
- Lesley T Bourne,
- Mario V Capanzana,
- Melanie J Cowan,
- Dulitha N Fernando,
- Regina M Fisberg,
- Brahmam NV Ginnela,
- Wilbur Hadden,
- Daniel J Hoffman,
- Nahla C Hwalla,
- Hajah Masni Ibrahim,
- Maria D Jackson,
- Lars Johansson,
- Hae-Jeung Lee,
- Chan Mei Fen,
- Gert BM Mensink,
- Rafael A Monge-Rojas,
- Balakrishna Nagalla,
- Marga C Ocke,
- Maciej Oltarzewski,
- Marja-Leena Ovaskainen,
- Gulden Ayla Pekcan,
- Stefka Petrova,
- Noppawan Piaseu,
- Leanne M Riley,
- Rusidah BT Selamat,
- Chansimaly Simmala,
- Laufey Steingrimsdottir,
- Gillian Swan,
- Lucjan Szponar,
- Heli Tapanainen,
- Robert Templeton,
- Anastasia Thanopoulou,
- Holmfridur Thorgeirsdóttir,
- Inga Thorsdottir,
- Aida Turrini,
- Nowak Verena,
- Anna Waskiewicz,
- Gábor Zajkás,
- Shadi Kalantarian,
- Pattra Wirojratana,
- Mary Anne Land,
- Tricia McKeever,
- Mohannad Abed Alfattah Al Nsour,
- Medical Science,
- Heléne Enghardt Barbieri,
- Aida Filipovic Hadziomeragic,
- Nur Indrawaty Lipoeto,
- Stephen T. McGarvey,
- Abdulrahman Obaid. Musaiger,
- Luz Gladys. Posada,
- Elz˙bieta Halina. Sygnowska
Affiliations
- 11 Kenya National Bureau of Statistics, Nairobi, Nairobi, Kenya
- J Lennert Veerman
- Griffith University School of Medicine and Dentistry, Gold Coast, Queensland, Australia
- Sarah Lewis
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- John Britton
- 4 Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
- Bruce Neal
- 1 The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Kathryn G Andrews
- 2 Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
- Goodarz Danaei
- associate professor
- Majid Ezzati
- MRC-HPA Centre for Environment and Health, Imperial College, London, UK
- Yanping Li
- 1 Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Yu Chen
- Department of Radiology, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, Hubei, China
- Farshad Farzadfar
- Jean-Michel Gaspoz
- Idris Guessous
- Unit of Population Epidemiology, Division of Primary Care Medicine, HUG, Geneva, Switzerland
- Lital Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel
- Paul Elliott
- Imperial College London, London, UK
- Carukshi Arambepola
- Department of Community Medicine, University of Colombo, Colombo, Western, Sri Lanka
- Antonia Trichopoulou
- 97 Hellenic Health Foundation, Athens, Greece
- Philippos Orfanos
- 16 Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, WHO Collaborating Center for Nutrition and Health, National and Kapodistrian University of Athens, Athens, Greece
- Martin C Gulliford
- King`s College London, UK, London, UK
- Renata Micha
- professor
- Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
- Wen-Harn Pan
- 18 Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Habibul Ahsan
- 21 Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
- Manami Inoue
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Luz Maria Sanchez-Romero
- Andrew Fogarty
- 2 Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK
- Christos Pitsavos
- 6 First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
- Edward Giovannucci
- 1 Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Stefaan De Henauw
- Stephen S Lim
- research fellow
- Cho-il Kim
- Executive Director, Korea Health Industry Development Institute, Cheongju, Republic of Korea
- Inge Huybrechts
- Didier Garriguet
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
- Simón Barquera
- director
- Katia Castetbon
- Epidemiology, Biostatistics and Clinical Research Research Center, ULB School of Public Health, Brussels, Belgium
- Neville Calleja
- 4Directorate for Health Information and Research
- Peilin Shi
- biostatistician
- Hsing-Yi Chang
- Yasuhiro Matsumura
- Hubert Barennes
- Guansheng Ma
- Shahab Khatibzadeh
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Saman Fahimi
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, Cambridge, UK
- John Powles
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, Cambridge, UK
- Morteza Abdollahi
- Anahita Houshiar-rad
- Eda Koksal
- Sahar Zaghloul
- Sirje Vaask
- Ana Baylin
- Simon Forsyth
- Rosely Sichieri
- Christian Haerpfer
- Ian Brown
- Division of Urology, Niagara Health System, Saint Catharines, Ontario, Canada
- Demosthenes B Panagiotakos
- Jacqui Webster
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Androniki Naska
- Dorothy Gauci
- Rebecca E Engell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Tim E Byers
- Stephanie Smith-Warner
- Ibrahim Elmadfa
- Mayuree Rao
- Pamela A Abbott
- Enrique O Abeyá Gilardon
- Suad N Al-Hooti
- Wulf Becker
- Peter Bjerregaard
- Lesley T Bourne
- Mario V Capanzana
- Melanie J Cowan
- Dulitha N Fernando
- Regina M Fisberg
- Brahmam NV Ginnela
- Wilbur Hadden
- Daniel J Hoffman
- Nahla C Hwalla
- Hajah Masni Ibrahim
- Maria D Jackson
- Lars Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Hae-Jeung Lee
- Chan Mei Fen
- Gert BM Mensink
- Rafael A Monge-Rojas
- Balakrishna Nagalla
- Marga C Ocke
- Maciej Oltarzewski
- Marja-Leena Ovaskainen
- Gulden Ayla Pekcan
- Stefka Petrova
- Noppawan Piaseu
- Leanne M Riley
- 2 Noncommunicable Diseases Department, WHO, Geneva, Switzerland
- Rusidah BT Selamat
- Chansimaly Simmala
- Laufey Steingrimsdottir
- Gillian Swan
- Office for Health Improvement and Disparities, United Kingdom Department of Health and Social Care, London, UK
- Lucjan Szponar
- Heli Tapanainen
- Robert Templeton
- Anastasia Thanopoulou
- Holmfridur Thorgeirsdóttir
- Inga Thorsdottir
- Aida Turrini
- Nowak Verena
- Anna Waskiewicz
- Gábor Zajkás
- Shadi Kalantarian
- Pattra Wirojratana
- Mary Anne Land
- Tricia McKeever
- Mohannad Abed Alfattah Al Nsour
- Medical Science
- Heléne Enghardt Barbieri
- Aida Filipovic Hadziomeragic
- Nur Indrawaty Lipoeto
- Stephen T. McGarvey
- Abdulrahman Obaid. Musaiger
- Luz Gladys. Posada
- Elz˙bieta Halina. Sygnowska
- DOI
- https://doi.org/10.1136/bmjopen-2013-003733
- Journal volume & issue
-
Vol. 3,
no. 12
Abstract
Objectives To estimate global, regional (21 regions) and national (187 countries) sodium intakes in adults in 1990 and 2010.Design Bayesian hierarchical modelling using all identifiable primary sources.Data sources and eligibility We searched and obtained published and unpublished data from 142 surveys of 24 h urinary sodium and 103 of dietary sodium conducted between 1980 and 2010 across 66 countries. Dietary estimates were converted to urine equivalents based on 79 pairs of dual measurements.Modelling methods Bayesian hierarchical modelling used survey data and their characteristics to estimate mean sodium intake, by sex, 5 years age group and associated uncertainty for persons aged 20+ in 187 countries in 1990 and 2010. Country-level covariates were national income/person and composition of food supplies.Main outcome measures Mean sodium intake (g/day) as estimable by 24 h urine collections, without adjustment for non-urinary losses.Results In 2010, global mean sodium intake was 3.95 g/day (95% uncertainty interval: 3.89 to 4.01). This was nearly twice the WHO recommended limit of 2 g/day and equivalent to 10.06 (9.88–10.21) g/day of salt. Intake in men was ∼10% higher than in women; differences by age were small. Intakes were highest in East Asia, Central Asia and Eastern Europe (mean >4.2 g/day) and in Central Europe and Middle East/North Africa (3.9–4.2 g/day). Regional mean intakes in North America, Western Europe and Australia/New Zealand ranged from 3.4 to 3.8 g/day. Intakes were lower (<3.3 g/day), but more uncertain, in sub-Saharan Africa and Latin America. Between 1990 and 2010, modest, but uncertain, increases in sodium intakes were identified.Conclusions Sodium intakes exceed the recommended levels in almost all countries with small differences by age and sex. Virtually all populations would benefit from sodium reduction, supported by enhanced surveillance.
